Dexmedetomidine to Levobupivacaine for Transversus Abdominis Plane Block in Elderly Patients Undergoing Inguinal Hernia Repair Surgery
Study Details
Study Description
Brief Summary
The perioperative management of pain following abdominal surgery can pose a challenge to anesthesia providers. Conventional practice has involved the use of opioids as well as neuraxial analgesic techniques. Unfortunately, these therapies are not without potential risks and side effects. These include nausea, vomiting, pruritus, urinary retention, constipation, respiratory depression, and sedation.
| Condition or Disease | Intervention/Treatment | Phase |
|---|---|---|
|
Phase 2/Phase 3 |
Detailed Description
As a result, the goal to reduce perioperative pain has taken on a multimodal approach.
Multimodal or "balanced" analgesia uses a combination of opioid and nonopioid analgesics to improve pain control and minimize opioid-related side effects. These include the use of nonsteroidal anti-inflammatory drugs, local anesthetics, peripheral nerve blocks, gabapentinoids, and alpha2 adrenergic agonists. Any combination of these therapies can help reduce the surgical stress response and improve patient outcomes such as pain control, patient satisfaction, time to discharge, and return to daily activities.
One method used in this multimodal approach is the transversus abdominis plane block. As first described by Rafi in 2001, this block provides analgesia to the anterolateral abdominal wall. In 2007, further studied this technique in patients undergoing large-bowel resection. He discovered a reduction in postoperative pain and morphine consumption in the first 24 hours postoperatively, resulting in fewer opioid-mediated side effects. In this same year, Hebbard described the use of ultrasound guidance to provide real-time imaging of the muscle layers and needle placement to improve TAP block accuracy. In 2008, Hebbard. described the subcostal approach of TAP blocks, to target the nerves of the upper abdomen. Transversus abdominis plane blocks continue to be studied and developed as an effective method for providing analgesia for numerous types of abdominal surgeries.
Study Design
Arms and Interventions
| Arm | Intervention/Treatment |
|---|---|
| Experimental: Group L 30 Patients will receive Levobupivacaine 5% |
Drug: Levobupivacaine
Levobupivacaine 5%
|
| Experimental: LD group 30 patients will receive Levobupivacaine 5% + 1 µg/kg dexmedetomidine. |
Drug: Dexmedetomidine Hydrochloride
Levobupivacaine 5% + 1 µg/kg dexmedetomidine.
|
| Experimental: LF group 30 patients will receive Levobupivacaine 5% + 1µg/kg fentanyl |
Drug: Fentanyl
Levobupivacaine 5% + 1µg/kg fentanyl
|
Outcome Measures
Primary Outcome Measures
- first analgesic request [24 hours postoperative]
time for the first analgesia rescue call.
Eligibility Criteria
Criteria
Inclusion Criteria:
-
ASA status I, II, and III patients,
-
aged 60-75 y,
-
both male and female,
-
undergoing inguinal hernia repair surgery.
Exclusion Criteria:
-
morbid obesity (BMI > 40),
-
spine metastatic tumor, allergy to an amide LA, or magnesium sulfate,
-
heart block, renal, or liver dysfunction, substance abuse disorder, chronic opioid use, or electrolyte disturbance, administration of any sedative, preexisting mental illness, psychological or emotional problems.
Contacts and Locations
Locations
| Site | City | State | Country | Postal Code | |
|---|---|---|---|---|---|
| 1 | Assiut governorate | Assiut | Egypt |
Sponsors and Collaborators
- Assiut University
Investigators
None specified.Study Documents (Full-Text)
None provided.More Information
Publications
None provided.- 17300618